Ask all women about abuse, says task force

NEW YORK (Reuters Health) - A government-backed panel on Tuesday recommended doctors ask their female patients about domestic violence they are currently experiencing or may have faced in the past.

The U.S. Preventive Services Task Force, an expert group that sets screening guidelines, said there is "adequate" evidence that asking about partner violence -- and referring women who need it to counseling services -- can reduce their mental and physical harm related to the abuse.

The guideline statement, which is still in draft form and available online for public comment, is based on a summary of the evidence for and against screening conducted by Oregon researchers for the task force and published last month (see Reuters Health story of May 7, 2012.)

"Violence is devastating to women and their families and it is good for us to be able to have a clear and strong recommendation that there is something that we can do," said Dr. Kirsten Bibbins-Domingo, a member of the task force and an epidemiologist at the University of California, San Francisco.

"The most important thing, the really key message I think in these recommendations, is that clinicians need to ask."

The task force concluded that a range of strategies -- including having women fill out a questionnaire in the waiting room or doctors asking a few brief questions during a check-up -- are effective for spotting those who are facing partner violence.

And there's also evidence that women who are referred for help, for example to a social worker, are more likely to leave an abusive partner -- or experience less abuse if they choose to stay in the relationship, the task force writes in the Annals of Internal Medicine.

The guidelines apply to women age 14 to 46 and update a 2004 statement in which the USPSTF determined there wasn't enough evidence to recommend for or against asking women about intimate partner violence.

"Fortunately since that time there have been many studies... (that suggest) asking and identifying women and then referring them to a range of potential types of interventions really does result in improved health outcomes for these women," Bibbins-Domingo told Reuters Health.

"The exciting thing is, the evidence is now out there," said Dr. Karin Rhodes, who has studied intimate partner violence at the University of Pennsylvania School of Medicine in Philadelphia and wasn't involved in the new guidelines.

Rhodes told Reuters Health organizations such as the American Medical Association have recommended asking women about partner violence for years, but screening had been hard to implement without evidence showing how well it works.

"We finally have the U.S. Preventive Services Task Force saying, 'This is a good idea,'" she said. "Now we have the imperative to get it done."

The task force still did not find enough evidence to say whether it's helpful and worthwhile to ask elderly or vulnerable adults -- such as those with a disability or brain damage -- about any abuse they may be experiencing.

When considering who should screen women for partner violence and how, Rhodes said the most important thing is that the conversations happen in private, confidential settings where women feel safe.

For its recommendation, the task force considered possible harms of screening, such as making women feel uncomfortable discussing partner violence.

"Sometimes I think clinicians may find it challenging to ask questions, that they're worried about sensitivity in women, they're worried about stigma," Bibbins-Domingo said.

But the panel determined that at most, the possible harms of asking about violence are "no greater than small" and are outweighed by the potential benefits of identifying abusive situations.

According to a 2010 survey by the Centers for Disease Control and Prevention, one-quarter of all American women have been the victim of severe physical violence committed by a partner at some point.